<%@ page language="java" import="java.util.*" pageEncoding="UTF-8"%>
<%@ taglib uri="/struts-dojo-tags" prefix="sd" %>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
  <head>
    <title>病人注册</title>
    <link rel="stylesheet" rev="stylesheet" href="<%=request.getContextPath() %>/page/patient/css/patientRegister.css" type="text/css" media="all" />
	<script type="text/javascript" src="<%=request.getContextPath() %>/js/jquery-1.7.1.min.js"></script>
	<script type="text/javascript" src="<%=request.getContextPath() %>/page/patient/js/patientRegisterValidation.js"></script>
     <sd:head extraLocales="en-us,nl-nl,de-de" />
  </head>
  
  <body class="ContentBody">
  <table width="100%" border="0" cellspacing="0" cellpadding="0">
	  <tr>
	    <td height="147" background="<%=request.getContextPath() %>/images/top02.gif"><img src="<%=request.getContextPath() %>/images/top03.gif" width="776" height="147" /></td>
	  </tr>
 </table>
  <form action="<%=request.getContextPath() %>/patientRegister.do" method="post" enctype="multipart/form-data" name="form" target="sypost" >
    <div class="MainDiv">
    <table width="100%" border="0" cellpadding="0" cellspacing="0" class="CContent">
       <tr>
          <th class="tablestyle_title" >病人注册</th>
       </tr>
       <tr align="center">
          <td class="TablePanel" id="result" style="font-size:20px;color:red;"></td>
		</tr>
       <tr>
        <td class="CPanel">
		      <TR>
			    <TD width="100%">
			     <fieldset style="height:100%;">
			     <legend>病人信息</legend>
				 <table border="0" cellpadding="2" cellspacing="1" style="width:100%">
					 <tr>
					    <td nowrap align="right" width="15%">病人姓名:</td>
					    <td width="35%"><input name='patient.patient_Name' type="text"class="text" style="width:154px" value=""  id="patient_Name" />
				            <span class="red">*</span>
				        </td>
				        <td nowrap align="right" width="18%">出生年月:</td>
					    <td width="35%">
					       <sd:datetimepicker value="%{''}" toggleType="wipe" toggleDuration="300" name="patient.patient_Birthday" id="patient.patient_Birthday"  cssClass="text" cssStyle="width:154px;"></sd:datetimepicker>
                           <span class="red">*</span>
				         </td>
					 </tr>
						
					 <tr>
					    <td nowrap align="right" width="15%">用户名:</td>
					    <td width="35%"><input name='patient.userName' type="text" class="text" style="width:154px" value="" id="userName"/>
					          <span class="red">*</span>
					    </td>
				        <td nowrap align="right" width="18%">联系地址:</td>
					    <td width="35%"><input name='patient.patient_Address' type="text" class="text" style="width:154px" value="" id="patient_Address" />
					         <span class="red">*</span>
					    </td>	
				     </tr>
					 <tr>	
						<td nowrap align="right" width="15%">密码:</td>
						<td width="35%"><input type="password" name="patient.userPassword" class="text" style="width:154px" id="userPassword"/>							
						    <span class="red">*</span>
						</td>
						<td nowrap align="right" width="18%">联系电话:</td>
						<td width="35%"><input name='patient.patient_Phone' type="text" class="text" style="width:154px" value="" id="patient_Phone" />
							<span class="red">*</span>							
						</td>
				       </tr>
					   <tr>
						  <td nowrap="nowrap" align="right">确认密码:<br></td>
						  <td><input name='confirmPassword' type="password" class="text" style="width:154px" value="" id="confirmPassword" />
						    <span class="red">*</span>
						  </td>	
						  <td nowrap="nowrap" align="right">手机号:</td>
						  <td><input name='patient.patient_MobilePhone' type="text" class="text" style="width:154px" value="" id="patient_MobilePhone" />
						    <span class="red">*</span>
						  </td>
					   </tr>
					   <tr>
						  <td nowrap="nowrap" align="right">邮箱:</td>
						  <td><input name='patient.patient_Email' type="text" class="text" style="width:154px" value="" id="patient_Email"/>
						    <span class="red">*</span>
						  </td>
						  <td  align="right" >性别:</td>
						  <td >
						    <select name="patient.patient_Sex" id="patient_Sex" >
                              <option  selected="selected">==请选择==</option>
                              <option>男</option>
                              <option>女</option>
                            </select>
                            <span class="red">*</span>
                          </td>
					  </tr>
					  <tr>
						  <td nowrap="nowrap" align="right">身份证号:</td>
						  <td><input name='patient.patient_IdentityID' type="text" class="text" style="width:154px" value="" id="patient_IdentityID"/>
						    <span class="red">*</span>
						  </td>
						  <td  align="right" >职业:</td>
						  <td >
						    <select name="patient.patient_Vacation" id="patient_Vacation">
                              <option  selected="selected">==请选择==</option>
                              <option>学生</option>
                              <option>老师</option>
                              <option>其他</option>
                            </select>
                            <span class="red">*</span>
                          </td>
					  </tr>
					  <tr>
					    <td  width="15%" nowrap align="right">备注:</td>
					    <td colspan="3"><textarea name="patient.patient_Remark" cols="100" rows="10" id="patient_Remark"></textarea></td>
					  </tr>
					 </table>
			         <br />
				</fieldset>			
			</TD>
		</TR>
		</TABLE>
		<TR>
			<TD colspan="2" align="center" height="50px">
			<input type="submit" name="save" value="保存" class="button" id="save"/>　
			<input type="button" name="Submit2" value="返回" class="button" onclick="window.history.go(-1);"/>
			</TD>
		</TR>
</div>
</form>
</body>
</html>
